Acceptability and Impact of a Breathing Awareness Meditation Application on Stress, Strain, Sleep Quality Among Caregivers of Kidney Transplant Recipients

Background:b> Caregivers are a crucial part of positive health outcomes for many chronically ill patients. Many caregivers experience stress and strain related to their caregiving role that may lead to neglecting their own health, both physical and mental, ultimately causing development of their own chronic illnesses.

Aim of the study:b> To evaluate acceptability and usability of a previously validated smartphone stress reduction app (Tension Tamer [TT]) among caregivers of kidney transplant recipients (KTR-Cs). An exploratory aim was to determine preliminary signals of efficacy of perceived stress, sleep quality, and blood pressure control.

Methods: A proof of concept randomized controlled trial with 20 KTR-Cs randomized into one of two groups: TT intervention arm or attention control (AC) arm. TT arm received a previously validated breathing awareness meditation (BAM) mobile application to use twice daily for three months while the AC arm received daily healthy education SMS messages. Study visits were conducted at baseline, 1-month, 2-month and 3-months visits.

Results:b> Mean age of the entire sample was 56.2±14.6 years, 72.7% female and 59.1% African American (40.9% white). Respondents averaged 19.3 ± 11.7 hours of caregiving/week, with 60% working full or part-time. There was a 100% participation rate and 90% retention rate. The majority of the sample (75%) at baseline self-reported high perceived stressed, 90% indicated poor sleep and 60.0% had high caregiver strain. Average adherence across the trial to the TT protocol (two 10 min sessions/day) was 71.8%. Compared to the AC group, the TT group experienced significantly greater improvements in perceived stress, caregiver strain, sleep quality and systolic blood pressure at 3-months (-8.7 vs +4.1mmHg, p<.05).

Conclusion: Results from this study indicate that a user friendly, BAM program may be efficacious in improving perceived stress, sleep quality and blood pressure control among KTR-Cs if tested in a properly powered RCT.

Keywords:Caregiver; Stress; Strain; Sleep; Breathing awareness meditation; Mobile health; Blood pressure

Abbreviations: KTR-C: Caregiver of kidney transplant recipient; MBSR: Mindfulness based stress reduction; mHealth: Mobile health; TT: Tension Tamer; BAM: Breathing Awareness Meditation; MBRT: Mindfulness based resilience training; AC: Attention Control; PSS: Perceived Stress Scale; CSI: Caregiver Strain Index; PSQI: Pittsburgh Sleep Quality Index; HTN: Hypertension; SBP: Systolic Blood Pressure